Flashcards in CHD/ACS Deck (41)
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1
What is classic ACS initial therapy
MONA---
Morphine
Oxygen
Nitro (vasodilation)
Aspirin
2
What are atypical symptoms of ACS that women can present with
Fatigue, GI, pulmonary
3
What is angina (general)
clinical syndrome w/ chest, jaw, shoulder, or arm discomfort attributable to coronary ischemia (supply too little for demand)
4
What are the subtypes of angina
-Typical: substernal, provoked by EXERTION/stress, relieved by REST
-Atypical: may be PLEURITIC, reproduced by palpation/MOVEMENT, lasts days or seconds
5
What is stable vs unstable angina
-Stable: develops w/ EXERTION, resolves with REST. short duration
-Unstable: develops AT REST/minimal exertion. lasts longer. D/t insufficient blood flow w/o myocardial necrosis
6
What is NSTEMI/STEMI
angina w/ elevated cardiac biomarkers indicating MI
-Actual muscle is dying
7
What is NSTE-ACS
imbalance of myocardial oxygen consumption and demand causing ischemia/infarct
8
How do you characterize an MI
High or low Troponin w/ at least 1 of following:
-Sx of ischemia
-New ST-T wave changes/LBBB
-Pathologic Q waves
-Loss of myocardium/new RWMA
-Intracoronary thrombus
9
What patients would you use an ischemia guided strategy in, and what is the strategy
Low risk score (TIMI 0-2)
Extensive comorbidities
-Start on meds and plan for stress test
10
What patients would you use an early invasive strategy in, and what is it
New ST depression, elevated trop, recurrent angina, CHF
-Send to cath lab
11
What are some causes of NSTE-ACS
Atherosclerosis
Vasospasm
Coronary embolism
Dissection
Non-obstructive (HTN, anemia, hyperthyroid)
12
What are some possible findings in CHD PE
Levine's sign
New S4
Paradoxical splitting of S2
New murmur
Pericardial friction rub
CHF/shock
13
What are the 3 P's that tell you its LESS likely to be a STEMI/NSTEMI
Palpable
Positional
Pleuritic
14
What are some CAD risk factors
DM
HTN
HLD
Tobacco
sex age FHx
ESRD
15
What categorizes ST depression and T wave changes
new ST depression 5mm (0.5mV) in 2+ leads
T wave inversion 1mm in 2+ leads
16
What is the ACS early branch system
Patient comes in with ACS
EKG
Biomarkers
Risk stratify to determine approach
17
How long does it take for Troponin to elevate
2-4 hours, persists 14 days
18
What are causes of elevated troponin
Tacky/brady arrhythmia
Shock
HTN
HF
Severe PE
Sepsis
Renal failure
19
When is CKD helpful
when diagnosing reinfarction and assessing perfusion
20
What are the TIMI risks
-Age 65+
-3+ CAD RF (HTN, DM, HLD, FHx, smoking)
-CAD
-Elevated cardiac biomarker
-ASA w/in 7 days
-ST elevation
-Severe angina
21
What are admission criteria for ACS
Recurrent symptoms
Ischemic changes on ECG
Elevated troponin
TIMI 3+
22
What are standard medical therapies for NSTE-ACS
Oxygen
Anti-Platelet (ASA&P2Y12 inhibitor/)
Statins (high intensity)
Nitro
Analgesics (NO NSAIDS)
23
What is a P2Y12 inhibitor
an anti platelet given WITH ASA
Clopidogrel (Plavix)
*If possible hold clopidogrel 5 days prior to surgery
24
What are GP IIa/IIb inhibitors
Anti-platelet used WITH ASA and heparin during AMI
25
What anti-HTN med takes precedence when treating NSTE-ACS
BB- given within first 24 hours (but NOT in CHF, HB, or asthma)
If BB contraindicated, use CCB
Add CCB to BB if with persistent angina
26
What are other NSTE-ACS therapies to initiate
ACE (if LVEF <40%
ARB
Ald. Antagonist (on ACE and BB with EF <40%)
27
What are stress test options
Exercise ECG
Echo (exercise or Dobutamine)
Myocardial perfusion imaging (exercise or adenosine)
--For those with abnormal baseline ECG
28
What are the most specific and sensitive stress tests for detecting CAD
Sensitive: Vasodilator nuclear MPI
Specific: Dobutamine Echo
29
What post-hospital care should be given to patients
+/- cardiac rehab (if rule in and have MI)
TLC
Aspirin
ACE/ARB
BB
30
